Pre-operative condition

Vinay was admitted to the Children's Hospital at 1145 hours on Wednesday, March 16, 1994 for surgical correction of his condition. On examination, Vinay was cyanotic with clubbed fingers. Since March 9 he had been treated with an antibiotic for an upper respiratory tract infection. In Vinay's pre-operative assessment, a physiotherapist heard breath sounds present throughout all lung fields, with a slightly harsh sound, especially in the left upper lobe.

At 1600 hours, Dr. H. Grocott, the anaesthesia resident, examined Vinay's chest and determined that his air entry was clear. He noted the child had had a mild upper respiratory-tract infection a week earlier with a runny nose, but no cough or fever. He assigned Vinay an anaesthetic class of ASA IV and noted that he was fit for anaesthesia. Swartz, the attending anaesthetist, also saw Vinay pre-operatively. She reviewed his history and tried to examine him. Both Grocott and Swartz made entries on the chart that the examination was difficult because Vinay was unco-operative. Swartz listed anticipated problems: arrythmias (irregular heart rhythm), coagulopathy and right ventricular failure post-operatively. She also assessed the child as ASA IV.

A chest X-ray taken on March 16 indicated that Vinay's lungs appeared essentially normal. The heart remained slightly enlarged, with evidence of right ventricular hypertrophy.